Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. [ncbi.nlm.nih.gov]

• Pain

  We describe the case of a 73-year-old woman with a history of chronic low back pain and 2 previous lumbar fusions who presented with complaints of worsening back and leg pain. [ncbi.nlm.nih.gov]

• Asymptomatic

  Mean patient age was 47±13.1 years (sex ratio 1.22); 59 (73.8%) presented with asymptomatic bacteriuria before the procedure. Nine (11.1%) UTIs were recorded on Day 14, of which one (1.2%) was febrile. [ncbi.nlm.nih.gov]

• Swelling

  Those include frequent urinary tract infections and urinary calculi (solid particles), kidney swelling (hydronephrosis), backward flow of urine from the bladder to the kidneys (vesicoureteral reflux), as well as kidney disease. [news-medical.net]

  A kidney and bladder ultrasound may be used to check for swelling of the kidneys and look at the bladder. A urodynamics study may be done to give the healthcare provider a detailed look at how well your child’s bladder and urethra work. [fairview.org]

  Potential side effects include allergic reactions, such as skin rash or swelling of the lips or tongue, chest pain, hallucinations and seizure 22. You may also experience sleeping problems, headache or nausea 22. [multiplesystematrophy.org]

  A kidney and bladder ultrasound may be done to check for kidney swelling and look at the bladder. You may also be asked to keep a record of your child’s urine habits. You’ll need to write down your child’s daily urinary schedule. [stanfordchildrens.org]

• Fecal Incontinence

  A child with neurogenic bladder and bowel underwent an antegrade continence enema procedure for fecal incontinence and severe constipation. She subsequently demonstrated an improvement in her neurogenic bladder and urinary incontinence. [ncbi.nlm.nih.gov]

  Originalsprog Dansk Tidsskrift Ugeskrift for Laeger Vol/bind 173 Nummer 39 Sider (fra-til) 2412-2415 Antal sider 4 ISSN 0041-5782 Status Udgivet - 2011 Anastomosis, Surgical, Animals, Autonomic Pathways, Defecation, Fecal Incontinence, History, 20th Century [pure.au.dk]

  Bowel control problems (fecal incontinence). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/Pubs/fecalincontinence/index.aspx. Accessed Jan. 23, 2018. Maitin IB, et al., eds. [mayoclinic.org]

• Nausea

  Common causes of neurogenic bladder are: blood in the urine (hematuria) BUN central nervous system tumors creatinine clearance CT scan electrolytes increased frequency of urination intravenous pyelogram nuclear scan of kidneys nausea and vomiting pain [columbiadoctors.org]

  Instead they may present with fever/chills, nausea, headache, increased spasticity, Autonomic Dysreflexia (AD). The majority of persons with spinal cord injury have bacteriuria therefore treatment should only be initiated if symptomatic. [rnoh.nhs.uk]

  You have nausea or are vomiting. You feel burning when you urinate. You have pain in your abdomen or lower back. You have bladder spasms. You see blood or clots in your urine. You are urinating less than usual. [drugs.com]

  You may also experience sleeping problems, headache or nausea 22. Botulinum Toxin If medication proves ineffective your doctor may recommend an injection of botulinum toxin into the bladder wall as an alternative. [multiplesystematrophy.org]

  Side effects may include fatigue, dry mouth, dizziness, blurred vision, nausea, and insomnia. Surgery. In extreme cases, when incontinence is severe and other treatments have failed, surgery may be considered. [greenville-urology.com]

• Diarrhea

  A 3-year-old girl with operated meningomyelocele and urinary incontinence presented with recurrent attacks of watery diarrhea and anuria, which were relieved by urethral catheterization. [ncbi.nlm.nih.gov]

  However, the complication rate was 38%; these were mostly grade 2, but notably included bowel dysfunction, diarrhea, fecal incontinence, and need for reintervention. [dovepress.com]

• Vomiting

  Common causes of neurogenic bladder are: blood in the urine (hematuria) BUN central nervous system tumors creatinine clearance CT scan electrolytes increased frequency of urination intravenous pyelogram nuclear scan of kidneys nausea and vomiting pain [columbiadoctors.org]

  You have nausea or are vomiting. You feel burning when you urinate. You have pain in your abdomen or lower back. You have bladder spasms. You see blood or clots in your urine. You are urinating less than usual. [drugs.com]

• Hypotension

  Used to lower outlet resistance Often used in combination with other methods Complications : Orthostatic hypotension (patients should take at night while lying down), interaction with phosphodiesterase inhibitors Anticholinergics Examples: Oxybutynin, [rnoh.nhs.uk]

• Blurred Vision

  Their most common side effect is dry mouth, although large doses may cause blurred vision, constipation, a faster heartbeat, and flushing. [greenville-urology.com]

  Side effects may include fatigue, dry mouth, dizziness, blurred vision, nausea, and insomnia. Additional drugs are being evaluated for the treatment of overactive bladder and may soon receive FDA approval. Surgery. [michiganurology.com]

  Side effects are typically antimuscarinic (dry mouth, constipation, blurred vision, drowsiness). [jnnp.bmj.com]

• Fracture

  Causes of CES include: Disc herniation in the low back Lumbar tumor Spinal fracture Infection Spinal stenosis affecting the spinal canal (central canal stenosis) Violent accidents: stabbing, gun shot, fall, car collision Congenital (born with) Treatment [spineuniverse.com]

  Introduction Spinal cord injury (SCI) can occur secondary to spinal column fracture after road traffic accidents or trauma or as a consequence of vascular ischemia or infection. [dovepress.com]

• Hip Pain

  A 21-year-old female with a history of a T7-8 level spinal cord injury at birth and subsequent neurogenic bladder dysfunction and bladder augmentation presented with an 8 month history of suprapubic pain, right hip pain and urgency unresponsive to antibiotic [ncbi.nlm.nih.gov]

• Stroke

  Neurogenic bladder, flaccid Neurogenic bladder, late effect of acute poliomyelitis Neurogenic bladder, late effect of stroke Neurogenic bladder, late effects of stroke Neurogenic bladder, spastic Paraplegia (paralysis of legs) with neurogenic bladder [icd9data.com]

  Neurogenic bladder leading to urinary incontinence has been described in patients of stroke, dementia, Parkinson's disease, and some schizophrenia cases with cognitive impairment possibly due to impaired cortical inhibition of the urinary bladder. [ncbi.nlm.nih.gov]

  If left untreated, the patient can have severe hypertension with systolic BP as high as 300mmHg and stroke, coma or death can occur. [ausmed.com]

  Neurogenic bladder at a glance Neurogenic bladder is a bladder control problem caused by a nerve, brain or spinal cord condition such as Parkinson’s disease, multiple sclerosis or a stroke. [denverurology.com]

  When conditions or abnormalities of the nervous system such as stroke, Parkinson’s disease, spinal cord injury and multiple sclerosis, as well as congenital birth defects such as spina bifida, adversely affect normal bladder function, the condition is [womenshealth.chesapeakeurology.com]

• Hyperactivity

  Hyperactive bladders posing with limit urine capacity may benefit from bladder augmentation surgery. [symptoma.com]

  Following a severe motor-vehicle accident involving massive blood loss, a 46-year-old man developed urinary urgency requiring catheterization, with hyperactive reflexes and bilateral Babinski signs on exam. [ncbi.nlm.nih.gov]

  In some cases the bladder may be hyperactive or hypoactive while the sphincter mechanism may be affected in the same or a different manner. [urologyweb.com]

  These can include: Alzheimer disease Birth defects of the spinal cord, such as spina bifida Brain or spinal cord tumors Cerebral palsy Encephalitis Learning disabilities such as attention deficit hyperactivity disorder (ADHD) Multiple sclerosis (MS) Parkinson [nlm.nih.gov]

• Areflexia

  The most common UD finding was overactive detrusor with no dysynergia (n = 31; 48%), followed by overactive detrusor with sphincter dysynergia (n = 16; 25%) and detrusor areflexia/underactive (n = 12; 18%). [ncbi.nlm.nih.gov]

  Lesions below L1 may have detrusor areflexia. [rnoh.nhs.uk]

  Injuries that involve the sacral spinal cord or cauda equina should result in a lower motor neuron lesion and detrusor areflexia. [ajmc.com]

  […] neurogenic bladder can be caused by injury affecting different levels of the nervous system, which can determine different clinical conditions: overactive bladder (OAB) with detrusor/sphincter dyssynergia (DSD), detrusor hyperactivity and ipereflexia or areflexia [veprints.unica.it]

• Incontinence

  Urinary incontinence happens when the bladder and sphincters dysfunction. Urge incontinence occurs with a spastic bladder or an overactive one. [symptoma.com]

  Thus, this technique may be used for urge symptoms, urge incontinence, and mixed incontinence (stress and urge incontinence). [emedicine.medscape.com]

  Further Reading What is Urinary Incontinence? Types of Urinary Incontinence Urinary Incontinence Diagnosis Urinary Incontinence Treatments Urinary Incontinence in Children [news-medical.net]

  Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention. Risk of serious complications (eg, recurrent infection, vesicoureteral reflux, autonomic dysreflexia) is high. [merckmanuals.com]

• Urinary Incontinence

  Further Reading What is Urinary Incontinence? Types of Urinary Incontinence Urinary Incontinence Diagnosis Urinary Incontinence Treatments Urinary Incontinence in Children [news-medical.net]

  Neurogenic bladder leading to urinary incontinence has been described in patients of stroke, dementia, Parkinson's disease, and some schizophrenia cases with cognitive impairment possibly due to impaired cortical inhibition of the urinary bladder. [ncbi.nlm.nih.gov]

• Urinary Retention

  Symptoms of urinary retention persisted at 1-year follow-up, despite self-catheterization and complete cessation of MDMA use. Chronic MDMA use may lead to neurogenic bladder and chronic urinary retention. [ncbi.nlm.nih.gov]

  These patients will often lack the sensation to void, which can also result in urinary retention. [ausmed.com]

  Neurogenic bladder can also contribute to the development of UTIs mostly caused by urinary retention. [multiplesclerosisnewstoday.com]

• Urge Urinary Incontinence

  […] storage symptoms (frequency, urgency, urge urinary incontinence) are present in 57% to 83% of patients with IPD, and voiding symptoms (poor force of stream, hesitancy, incomplete emptying) are seen in 17% to 27% of this patient population.12 For most [ajmc.com]

In the work-up and management of neurogenic bladder, the following diagnostic modalities are used:

• Ultrasound of the kidney determines sign of obstruction and enlargement (hydronephrosis)
• Serum creatinine determination will show the extent of kidney damage
• Post void residual volume determination will predict the amount of urine retained in the bladder
• Cystoscopy is the direct examination of the bladder using a flexible cystoscope via the urethra
• Cytometrography will demonstrate the pressure involved in the bladder

Medical management of neurogenic bladder includes the oral intake of bladder relaxants like oxybutynin, and tolterodine for the treatment of a spastic bladder. Botulinum toxins may be used with local infiltration to the bladder to reduce its spasticity [5]. Hyperactive bladders posing with limit urine capacity may benefit from bladder augmentation surgery [6].

Patients with difficulty initiating and sustaining urination may benefit with an indwelling catheter or an intermittent straight catheterization for easier voiding. A urinary bladder “pacemaker” may be implanted to automatically stimulate its nerves for functionality purposes.

The surgical repair of the sphincter and the sling muscle will improve incontinence issues. For permanent voiding access, a stoma (cystostomy) may be created from the abdomen to the bladder for better and hygienic voiding options. Some variant of cystostomy may have an ileal conduit for better quality of life in patients [7].

Prognosis in neurogenic bladder depends on the level of the nerve damage. The more central (near the brain) the damage the more complications are expected. Brain damage carries a grim outlook because it hampers hormonal control (antidiuretic hormones), regional nervous and muscle control (detrusor muscle, sphincter and the urinary bladder). Surgical methods for neurogenic bladder may give an excellent outlook for the patient.

Complications

Hydronephrosis or the hydrostatic enlargement of the kidneys occurs due to the return pressure exerted by the ureters to the kidney when free flow of urine to the bladder is impeded because of a chronic neurogenic bladder condition. Kidney enlargement may lead to renal failure if left untreated and can eventually lead to death. Recurrent urinary tract infections (UTI) may be experienced with vesico-urethral reflux because of sphincter hyperactivity with neurogenic bladders. The most common pathogen in UTI among neurogenic bladder patients are Escherichia coli, Entrococcus and Pseudomonas aeruginosa [2]. The recurrent urinary tract infection is caused by the persistent stasis of urine in the bladder [3].

The constant urine leakage may cause pressure or bed sores to dependent parts of the skin especially in the back and in the buttocks. Patients with multiple sclerosis succumbs to the incontinent type of neurogenic bladder which are also associated with uterine prolapse among female patients [4].

Any disorder in the central nervous system that affects the brain and the lower body may lead to neurogenic bladder. The following etiology has been noted to amongst the most common:

• Spinal cord defect – birth defects like spina bifida
• Brain or spinal cord tumors
• Cerebral palsy
• Alzheimer’s disease
• Encephalitis (viral or bacterial)
• Severe Attention Deficit Hyperactivity (ADHD)
• Multiple sclerosis
• Parkinson’s disease
• Trauma to the spinal cord
• Cerebrovascular disease (stroke)
• Metabolic neuropathy (Diabetic and alcoholic neuropathy)
• Illicit drug use like MDMA or “ecstasy” can cause chronic urine retention [1]

The incidence of neurogenic bladder is variably dependent on the individual incidences of the primary disease or pathology that gave rise to them. In patients diagnosed with multiple sclerosis, the incidence of neurogenic bladder reaches 20 to 30% within 10 years from diagnosis but for those with detrusor muscle paralysis, 30 to 50% will present in incontinent type of paralysis.

Scientific data have shown that the incidence of neurogenic bladder in Idiopathic Parkinson’s disease (IPD) is 57% to 83% which manifests as incontinence, urgency and frequency symptoms. In traumatic spinal cord injuries, patients will present with some of bladder dysfunction within the year of the trauma in approximately 81% of cases.

Young adults suffering from spina bifida will show signs of urinary incontinence in up to 61% of cases. The incidence of neurogenic bladder in these cases are dependent on the anatomic location of the lesion and the extent of nerve damage.

Neurogenic bladder may occur when the central nervous system sustains damage in the level of the brain, pons, sacral cord and the peripheral nerves. Nerve damage will lead to dysfunctional voiding condition ranging from mild urinary retention to an overactive bladder (OAB).

Urinary incontinence happens when the bladder and sphincters dysfunction. Urge incontinence occurs with a spastic bladder or an overactive one. Uncontrolled voiding with stress incontinence manifests when neurogenic sphincter control and the detrusor muscle is compromised.

Neurogenic bladder may be prevented only by preventing the primary medical and surgical conditions that cause it. For patients diagnosed with multiple sclerosis, the 10 year interval before signs of neurogenic bladder starts will give enough time for them to do pelvic floor strengthening exercises (Kergel exercises) to improve incontinent problems. Children with neurogenic bladder may be allayed by regular nocturnal emptying of urine to prevent leaks and incontinence [8].

Patients who have undergone abdominal surgery or those with recent trauma should do early ambulation and exercises to prevent neurogenic bladder from ensuing. Neurogenic bladder with increased risk for recurrent UTI has been found to benefit from bladder inoculation with Escherichia coli antigen which lowers the incidence of UTI episodes per year [9]. Studies have revealed that the regular intake of cranberries tablet has been demonstrated to reduce incidence of UTI in a third of all compliant subjects [10].

Neurogenic bladder must be viewed as a complication of a primary disease thus any damage to the nerves (spinal) must be brought to medical attention for the proper diagnosis of impending nerve damage. Those diagnosed with neurogenic bladder must learn to identify signs of early urinary tract infection for prompt treatment and averting complications. Catheter and stoma care should always remain sterile to prevent secondary infections.

1. Beuerle JR, Barrueto F. Neurogenic bladder and chronic urinary retention associated with MDMA abuse. J Med Toxicol. 2008; 4(2):106-8 
2. Romero-Cullerés G, Planells-Romeo I, Martinez de Salazar-Muñoz P, Conejero-Sugrañes J. Urinary infection in patients with neurogenic bladder: patterns of resistance to the most frequent uropathogens. Actas Urol Esp. 2012; 36(8):474-81 
3. Balsara ZR, Ross SS, Dolber PC, Wiener JS, Tang Y, Seed PC. Enhanced susceptibility to urinary tract infection in the spinal cord-injured host with neurogenic bladder. Infect Immun. 2013; 81(8):3018-26 
4. Dillon BE, Seideman CA, Lee D, Greenberg B, Frohman EM, Lemack GE. A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic. J Urol. 2013; 189(3):976-9
5. Kanai A, Zabbarova I, Oefelein M, Radziszewski P, Ikeda Y, Andersson KE. Mechanisms of action of botulinum neurotoxins, β3-adrenergic receptor agonists, and PDE5 inhibitors in modulating detrusor function in overactive bladders: ICI-RS 2011.Neurourol Urodyn. 2012; 31(3):300-8 
6. Stein R, Schröder A, Thüroff JW. Bladder augmentation and urinary diversion in patients with neurogenic bladder: surgical considerations.J Pediatr Urol. 2012; 8(2):153-61 
7. Guillotreau J, Castel-Lacanal E, Roumiguié M, Bordier B, Doumerc N, De Boissezon X, Malavaud B, Marque P, Rischmann P. Prospective study of the impact on quality of life of cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction. Neurourol Urodyn. 2011; 30(8):1503-6 
8. Koff SA, Gigax MR, Jayanthi VR. Nocturnal bladder emptying: a simple technique for reversing urinary tract deterioration in children with neurogenic bladder. J Urol. 2005; 174(4 Pt 2):1629-31; discussion 1632 
9. Darouiche RO, Green BG, Donovan WH, Chen D, Schwartz M, Merritt J, Mendez M, Hull RA. Multicenter randomized controlled trial of bacterial interference for prevention of urinary tract infection in patients with neurogenic bladder.Urology. 2011; 78(2):341-6 
10. Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord. 2008; 46(9):622-6